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Registered nurses are delaying retirement, a work decision that will help make new accountable care models and the move away from fee-for-service medicine more achievable under the Affordable Care Act.

Nearly a quarter, or 24 percent of registered nurses, were working as late as age 69. The trend has helped extend nursing careers by 2.5 years after age 50 and “increased the 2012 RN workforce by 136,000 people,” RAND researchers say.

These work choices will be critical given the worsening physician shortage and reimbursement changes by government and private insurers to encourage the use of more allied health professionals such as RNs, nurse practitioners, physician assistants and pharmacists to meet the demand of more newly insured Americans under the health law.

Health insurance companies, employers and government health programs are coaxing Americans more toward a system of population health via patient-centered medical homes and accountable care organizations and away from traditional fee-for-service medicine that encourages unnecessary tests and procedures. Under the new so-called value-based approaches of accountable care, primary care providers work harder, typically as a more coordinated team, to keep patients out of the hospital, ensuring they are taking their medications and getting care upfront in a doctor's office, a health center or even a retail clinic.

ACOs and other new models of health care delivery, which are pushed by the biggest of insurance companies like (AET), (CI), (HUM), (UNH) and Blue Cross and Blue Shield plans, see registered nurses being a critical part of the team that helps the physician coordinate care.

“ACA-induced changes in care delivery, combined with the Medicaid and marketplace insurance expansions that have begun, suggest that there will be an increase in the demand for RNs in care coordination, management, and ambulatory care positions,” Auerbach and co-authors Peter Buerhaus of Vanderbilt University and Douglas Staiger of Darmouth College wrote in their six-page article published in the August issue of Health Affairs.

The increase in nursing comes from several different forces such as a major focus on enhancing nurse education. That more than doubled the number of nurses to 181,000 in 2012 from about 74,000 in 2002, RAND said.

Though more than 85 percent of nurses under 30 work in hospitals, RAND researchers say they move to and are interested in working outside of the hospital as they age. Thus, employers will find this shift a welcome development.

“Older RNs are far more likely to work outside of the hospital than younger RNs are – and thus the large number of older RNs seeking nonhospital employment could be a welcome development for nonhospital organizations that are seeking RNs,” the study’s authors wrote. “Hospital-based RNs are often well versed in competencies involving patient transitions and care coordination.”